Eosinophilic Granulomatosis with Polyangiitis presenting as Mononeuritis Multiplex

Eosinophilic Granulomatosis with Polyangiitis (EGPA), formerly known as Churg-Strauss Syndrome, is a anti-neutrophil cytoplasmic antibody (ANCA) associated vasculites affecting small vessels. We describe a women with subacute complaints of paresthesias, disesthesias, crural paraparesis with lost of gait and purpuric lesions on her ankle. Electromyogram revealed multiplex mononeuropathy with left median nerve, right ulnar and femoral nerves involvement. Laboratory analysis with eosinophilia and positive ANCA. She fulfilled the Chapel Hill Conference Consensus definition and the criteria of American College of Rheumatology for EGPA. Corticosteroids and cyclophosphamide were begun with good clinical and laboratorial response. This report ilustrates the importance of identifying the neuropatic pattern as initial manifestation of this rare condition that can cause significant disability if there is delay on the diagnosis and treatment.